08/23/2017

PAediatrics mci screening test and indian medical pg examz high yield important topics study tips

By Live Dr - Wed Feb 11, 3:23 am

PAediatrics

*Average birth weight- 3kg

Newborn gains weight at the rate of 25 grams per day for the first 3 months

Doubling of weight occurs at 5 months

Tripling by 1 year

Quadruples by 2 years

*Average newborn length- 50 cm

Increases by 25 cm in first year

Then by 12.5 cm in second year

Then 6 cm in third year

Child is 100 cm tall at the end of fourth year

*Head circumference at birth is 35 cm

Circumference of chest is 3 cm less than head circumference at birth

Equals head circumference by 1 year of age

*At birth the upper segment is to lower segment ratio is 1.7

*Normal temperature of neonate is 36.5-37.5 degrees

Normal heart rate-100-160 / min

Normal respiratory rate is- 40-60 / min

*Anterior fontanelle- 2 x 5 cm

Posterior fontanelle- 0.5 cm in diameter

Low birth weight < 2500 gm
At risk low birth weight < 2000 gm
Very low birth weight < 1500 gm
Very very low birth weight/ extremely low birth weight < 1000 gm
Small for gestational age < 10th percentile for that gestational age
Appropriate for gestational age 10th – 90th percentile for respective gestational age
Large for gestational age > 90th percentile
Preterm < 37 weeks  / <258 days
Term 37-42 weeks / 259-293 days
Post term > 42 weeks /  >294 days

QUOTE CORNER

To accomplish great thing we must dream as well as act-Anatole France

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Foetal death

CHARACTERISTIC early fetal death intermediate fetal death late fetal death
Gestational age 20-22 weeks 22-28 weeks > 28 weeks
Weight <500 gm 500-1000 gm >1000 gm
Crown-heel Length <25 cm 25-35 cm > 35 cm

NEONATAL REFLEXES

reflex appears disappers
moros reflex

When the head is suddenly released there is abduction and extension of arms, followed by slow adduction and flexion of arms, resembling in an embrace

After 28 weeks of intrauterine gestation Disappears after 4 months of age
rooting

When breast is brought in contact with infant’s cheek, it seeks nipple.

sucking reflex

Tactile stimulation of  neonate’s mouth leads to vigorous sucking

Present at birth 4 months of age
asymmetric tonic neck reflex

When head is rotated to one side, there is hypertonia seen in the upper limb of the same side and extension of the lower limb

Appears at birth 4-5 months
palmar / plantar grasp reflex

On stimulation of the palm/ sole, there if flexion of fingers /toes.

At birth 4 months
parachute reflex

When a ventrally suspended baby is suddenly lowered there is extension of arms

8 months Throughout life
landaus reflex

When the head of a ventrally suspended child is lowered, there is flexion of upper and lower limbs

6 months 15-18 months

*Head circumference in first year

Length + 9.5 +/- 2.5

2

*Formula for height (more than 2 years)

(Age x 6) + 77

TRIVIAL TRUTH

Babies’ eyes do not produce tears until the baby is approximately six to eight weeks old.

ELEVENTH HOUR PAEDIATRICS                                                                                                        183

Formula for weight

3months to 1 year Age + 9

2

1-6 years (2 x age) + 8
6-12 years (7 x age) -5

2

DEVELOPMENTAL MILESTONES

Gross motor

age (months) activity

3

Neck holding

5

Sitting with support

8

Sitting without support

9

Walking with support

10

Walking without support

11

Crawling

12

Standing without support

13

Walking without support

18

Running

24

Walking upstairs

36

Riding a tricycle

Fine motor

age activity

4

Grasping

5

Intentional reaching with bidextrous grasp

7

Palmar

9

Pincer

Language

age (months) activity

1

Turns head to sound

3

Cooing

6

Monosyllables

9

Bisyllables

12

2 words with meaning

24

Simple sentences

36

Story telling

QUOTE CORNER

Opportunity is missed by most men because it is dressed in overalls and look like work -Thomas A. Edison

ELEVENTH HOUR PAEDIATRICS                                                                                                          184

Social

AGE (MONTHS) ACTIVITY

2

Social smile

3

Recognizes mother

6

Smiles  mirror image

9

Waves bye-bye

12

Plays a simple ball game

15

Identifies body parts

36

Knows gender

Growth charts

Who growth charts

Upper curve Median for boys- 50th percentile of Boston / Harvard standards
Lower curve Median for girls- 3rd percentile of Boston / Harvard standards

Government of India growth chart

First curve 50th percentile  i.e. 80 %
Second curve

70%

Third curve

60%

Fourth curve

50%

Well-Come CLASSIFICATION, using Harvard standards

Children between 60-80 % of expected weight without edema Underweight
Children between 60-80 % of expected weight with edema Kwashiorkor
Children below 60% of expected weight without edema Marasmus
Children below 60% of expected weight with edema Marasmic kwashiorkor

IAP grading of PEM

Grade 1 70-80 % of 50th percentile
Grade  2 60-70 % of  50thn percentile
Grade 3 50-60 % of 50th percentile
Grade 4 <50 % of 50th percentile

Waterlow’s classification

condition weight/ age height/ age weight/height
Recent malnutrition

Normal

Past malnutrition

↓↓

Chronic malnutrition

↓↓

↓↓

Normal

TRIVIAL TRUTH

Chocolate contains phenyl ethylamine (PEA), a natural substance that is reputed to stimulate the same reaction in the body as falling in love.

ELEVENTH HOUR PAEDIATRICS                                                                                                           185

Shakeer’s tape

colour zone

mid-arm circumference

interpretation(for children between 1-5 years)

Green

> 13.5 cm

Well nourished

Yellow

12.5-13.5 cm

Borderline

Red zone

< 12.5 cm

Malnourished

*Kwashiorkor

Flag sign- Alternate bands of hypopigmented and normally pigmented hair

Flaky paint dermatosis- hyperpigmented patches of skin desquamate to expose raw hypopigmented skin

*Breast milk has

70 cal / 100ml

Proteins 1.1 gm / 100ml

7 gm lactate / 100 ml

*Expressed breast milk can be stored at

Room temperature of 8 hours

In refrigerator for 24 hours

In cold room for 3 months

*Bifidus factor is protective in infections caused by E. coli

who classification of xerophthalmia

X1A Conjunctival xerosis
X1B Bitot’s spots
X2 Corneal xerosis
X3A Corneal ulceration
X3B Keratomalacia
XN Night blindness
XF Fundal changes
XS Corneal scarring
Treatment of vitamin a deficiency
2 lac units immediately

2 lac units on second day

And 2 lac units after 14 days

Infants (less than 1 year)

Should be given 1 lac iu

Water miscible retinol palmitate injection can be given in those with continuous vomiting

QUOTE CORNER

Symptoms are the body’s mother tongue; signs are in a foreign language.- John Brown

ELEVENTH HOUR PAEDIATRICS                                                                                                           186

caloriC requirement in children

age (YEARS) boys girls

1

1000 900

2

1200 1100

3

1400 1300

4

1600 1500

5

1700 1600

6

1800 1700

7

1900 1800

8

2000 1900

9

2100 200

10

2200 2100

IMMUNISATION SCHECULE AS PER IAP

Birth-15 days bcg, opv zero dose, hepatitis b 1st dose
6-8 wks opv 1, dpt 1 hepatitis b 2nd dose, hib 1st dose
10-12 weeks opv2. dpt 2, hib 2nd dose
14-16 weeks opv 3, dpt 3, hepatitis b 3rd dose, hib 3rd dose
9 months completed measles
15-18 months dpt and opv booster dose 1, mmr vaccine
4-6 years 2nd booster dose of opv and dpt
10 years Tetanus toxoid
16 years Tetanus toxoid

Neonatal Hyperbilirubinemia

Unconjugated Hyperbilirubinemia
Criggler -Najjar syndrome- udp glucuronyl transferase deficiency

Gilbert’s syndrome-Decreased activity of udpgt

Decreased hepatic uptake of bilirubin

Conjugated Hyperbilirubinemia
Rotors syndrome and Dubin Johnson syndrome- deficiency in excretion of bilirubin

A cardinal feature of Dubin -Johnson syndrome is accumulation in Lysosome of Centrilobular hepatocytes of dark, coarsely granular pigment. As a result, liver may be grossly black in colour; the pigment is derived from epinephrine metabolites tan are not excreted normally

*Clinical jaundice in neonate, when bilirubin level is more than 5mg/dl

First sign of congenital hypothyroidism in neonate is persistent elevation of indirect Kernicterus is seen when bilirubin> 20 mg/dl

Bronze baby syndrome is seen with phototherapy

TRIVIAL TRUTH

A salt enema used to be given to children to rid them of threadworms.

ELEVENTH HOUR PAEDIATRICS                                                                                                           187

Pathological jaundice
Clinical jaundice appearing in first 24 hours

Increase in level of total bilirubin by more than 0.5 mg/dl/24 hours

Total bilirubin > 15 mg/dl

Direct bilirubin > 2 mg/dl

Ophthalmia neonatorum

bacteria incubation period
Gonococcal

Chemical

< 48 hrs

Other bacteria

2-3 days

H. Simplex

5-7 days

Causative agents of meningitis

age group cause
Neonate Group B streptococci
< 2 months E.coli
2 months to 2 ½  years H. influenza
2 ½ years- 20 years Meningococci
> 20 years Pneumococcus

*Commonest cause of Ventriculoperitoneal shunt infection is staphylococcus epidermidis

Pierre Robinson syndrome
Micrognathia

Glossoptosis with pseudo macroglossia

High arched palate or cleft palate

*Retinopathy of prematurity

Predisposing factor is prematurity

Precipitating factor is hyperoxia

*Commonest congenital anomaly of cns is neural tube defects -1.5 / 1000 live births

Screening test for prenatal detection of neural tube defects- Maternal serum alpha Fetoprotein levels at 12-16 weeks

Confirmatory test is USG

Prevented by periconceptional Folic acid  > 6 weeks before conception to first trimester

*Atrial septal defect

Most common atrial septal defect involves fossa ovalis, is midseptal in location, and is of ostium secumdum type

QUOTE CORNER

The significance of a man is not in what he attains but in what he longs to attain.- Kahlil Gibran

ELEVENTH HOUR PAEDIATRICS                                                                                                          188

Tachypnoea

0-2 months

More than 60 / min

2months to 12 months

More than 50 / min

1-5 years

More than 40 / min

*Tracheo-esophageal fistula

Commonest variety- upper part of the esophagus ends blindly and the lower part is connected to trachea

*Commonest congenital acyanotic heart disease is ventricular septal defects

Commonest congenital cyanotic heart disease is tof

Condition in which there can be ccf without cardiac enlargement
Congenital mitral stenosis

Cor triatriatum

Obstructive variety of total anomalous pulmonary venous connection

*Patients with left to right shunts develop ccf at the age of 6-8 weeks

*Roger’s defect- small vsd, presenting with a loud murmur

*Lutembacher syndrome

ASD with mitral valve stenosis

Nadas’ criteria for diagnosis of heart disease

Major criteria Minor criteria
Systolic murmur of grade III or more

Diastolic murmur

Cyanosis

Congestive cardiac failure

Systolic murmur less than grade III

Abnormal S2

Abnormal ecg

Abnormal x-ray

Abnormal blood pressure

Presence if 1 major or 2 minor criteria are essential for diagnosis.

systemic pulmonary shunts

shunt description
Blalock-Taussing Subclavian artery-Pulmonary artery anastomosis
Pott’s shunt Descending aorta -Pulmonary artery
Waterson’s shunt Ascending aorta- Right pulmonary artery
Modified B-T shunt Same as above but uses Gore-tex conduit
Glenn svc with right Pulmonary artery

TRIVIAL TRUTH

Banging your head against a wall uses 150 calories an hour

ELEVENTH HOUR PAEDIATRICS                                                                                                           189

Holt oram syndrome
Thumb hypoplasia

Hypoplasia of clavicle

Asd

First degree heart block

Late manifestations of syphilis

Stigmata of initial lesionS Late hypersensitivity reactions
Hutchinson’s teeth

Frontal bossing

Short maxilla

Saddle nose

High arched palate

Enlargement of sternoclavicular portion of clavicle

Protuberant mandible

Radiating perioral scars /Rhagades

Saber tibia

Mulberry molars

Interstitial keratitis

Nerve deafness

Clutton’s joint

Hutchinson’s triad- Congenital syphilis
Hutchinson’s teeth

Interstitial keratitis

8th nerve deafness

classification of mental retardation by iq

Mild 50-70
Moderate 35-50
Severe 20-35
Profound <20
Duchenne muscular dystrophy
Pseudohypertrophic muscular dystrophy

Cause by mutation in the gene, located at xp21 that encodes dystrophin

X-linked recessive disorder

Valley sign-groove between supraspinatus and teres minor increases on abduction of shoulder.

Gower’s sign-

The sign describes a patient that has to use his or her hands and arms to “walk” up his or her own body from a squatting position due to lack of hip and thigh muscle strength.

QUOTE CORNER

The whole purpose of education is to turn mirrors into windows.-Sydney J. Harris

ELEVENTH HOUR PAEDIATRICS                                                                                                           190

Gowers’ signs:
There are three Gowers’ signs:

1 Pain along the compressed sciatic nerve on passive dorsiflexion of the foot;

2 The irregular contraction of the pupil in early tabes (Argyll Robertson);

3 The climbing up the legs signs in Duchenne dystrophy

Signs of latent teatany

Trosseau’s sign Carpal spam is elicited by occluding brachial artery, by inflating a pressure cuff for 3 minutes.

Carpal spasm is seen as flexion at the wrist and metacarpophalangeal joints, extension of proximal and distal interphalangeal joints, adduction of thumb and fingers.

Chvostek sign  /  Weiss’ sign When facial nerve is tapped at the angle of mandible , facial muscles go into spasm (twitching of nose or lips)
Peroneal sign The peroneal sign consists of dorsiflexion and abduction of the foot on tapping the peroneal nerve on the lateral surface of the fibula just before the knee.
Erb sign Increased electric irritability of motor nerves in tetany.

*Ecg manifestation of hypocalcaemia is prolonged QT interval

*Hypocalcemic seizures occur below 7mg/dl

Hypoglycemia is defined as blood glucose < 40 mg/dl

acute itp chronic itp
4-6 weeks of duration > 6 months / year
Acute onset Insidious onset
Antecedent infection is common Not so
Spontaneous remission in majority Unlikely
loss of alpha gene manifestation

1

Silent carrier state

2

Alpha Thalassemia trait

3

Hemoglobin h disease

4 (all)

Hydrops fetalis

*Earliest bony change in Thalassemia is rectangular appearance of short bones of hand

Osmotic fragility is decreased

*Fetal Hb at birth 70%

Complete conversion of fetal Hb to adult is done by 6-12 months

TRIVIAL TRUTH

The human eye can detect more than 10,000,000 different colors!

ELEVENTH HOUR PAEDIATRICS                                                                                                           191

most common malignancies in children in descending order
Leukemia

Lymphoma

Brain tumors

Neuroblastoma

Retinoblastoma

Wilm’s tumor

*Brain tumors in children

Most common Subtentorial – Cerebellar astrocytoma: also has best prognosis

Medulloblastoma -Second most common; most radiosensitive

Most common supratentorial -Craniopharyngioma

Worst prognosis is seen with- Glioblastoma multiforme

Sickle cell anemia

Vaso-occlusive crisis / painful crisis due to blockade of end organ capillaries  resulting in ischemia, pain and organ damage
Aplastic crisis Acute worsening of anemia producing pallor, tachycardia and fatigue. Precipitated by Parvovirus B 19 infection. Erythropoeisis is stopped for 2-3 days.
Splenic sequestration crisis Acute painful enlargement of spleen.

Also shows hand-foot syndrome

Hyperhemolytic crisis

*Hemochromatosis shows

Bronze skin

Cirrhosis

Diabetes mellitus

*Polio

Most commonly affected muscle is quadriceps

Most common complete paralysis is seen in Tibialis anterior

Most commonly affected muscle in hand is opponens policis

*Most common cause of paralytic polio is type 1 polio virus

*Sudamen-

Noninflammtory eruption from sweat glands, seen in febrile illnesses,

Pearly white vesicles, self-limited

QUOTE CORNER

Competence, like truth, beauty and contact lenses, is in the eye of the beholder.-The Peter Principle by Laurence J. Peter

ELEVENTH HOUR PAEDIATRICS                                                                                                          192

*Erythema infectiosum-

Fifth disease

Slapped cheek appearance (maculopapular rash)

Sixth disease -Roseola infantum or exanthema subitum-Human Herpes virus 8

order of puberty in girls
Thelarche

Adrenarche

Height

Menarche

gilles de la torette syndrome
Multiple motor tics

Vocal tics

adhd

ocd

*laron syndrome-

Clinical features of growth hormone deficieny in the presence of  elevated levels of growth hormone

cherubic facies is seen in growth hormone deficiency

*Blueberry muffin rash

Dermal nests of extrmedullary hematopoeisis

*Alice in wonderland syndrome is associated with EBV virus

*Celery stalk lesions at ends of femur and humerus are seen in congenital rubella, cmv and hsv infection

*Commonest cause of an abdominal mass in a newborn – multicystic dysplastic kidney.

*Rheumatoid factor is positive in only polyarticular variant of JRA

It is negative in pauciarticular and systemic variants of JRA

*Symptoms of scurvy are painful legs

Frog like posture

TRIVIAL TRUTH

Ophthalmic surgery was one of the most advanced areas of medicine in the ancient world. Detailed descriptions of delicate cataract surgery with sophisticated needle syringes is contained in the medical writings of Celsus (A.D.14-37)

ELEVENTH HOUR PAEDIATRICS                                                                                                         193

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